Where comprehensive headache care meets women’s neurology subspecialty offerings

Neurology and headache specialists at Novant Health in Charlotte offer comprehensive care for head and face pain to adult men and women 18 and up. The Charlotte team is equipped to address a range of conditions, including trigeminal neuralgia, atypical facial pain, migraine, tension headaches, cluster headaches, headaches caused by medication overuse and headaches associated with long COVID-19. Services offered include headache infusions for refractory headache, as well as Botox procedures and Vyepti infusions for chronic migraines.

Also in Charlotte are subspecialists who address neurological conditions in women who are considering pregnancy, who are pregnant or who are lactating.

“It’s important to have this subcategory because a lot of providers feel uncomfortable seeing patients who are pregnant, because there’s such a limitation in terms of what medications can be used safely and what risks come with someone who has a headache in pregnancy,” said Megan Donnelly, DO, head of the Comprehensive Headache Center and women’s neurology at Novant Health. “There is a higher risk of there being a secondary cause of headache, such as cerebral venous thrombosis, or headaches secondary to preeclampsia. There’s a higher rate of stroke and bleeding in patients, for example, who have an aneurysm and are pregnant.”

The headache center team, which includes five headache specialists — with Jessica Parker, MD, most recently joining – takes in a variety of referrals from clinicians, including primary care physicians, neurologists and obstetricians. Here are fast facts about the Novant Health team’s referrals, diagnostics, consultations and care plans.

Patients are most commonly referred to the Novant Health team for migraines.

Dr. Donnelly: “Migraine is what we see the most of. Typically, patients see their primary care doctor, who identifies that this is migraine and tries one or two different medication options, but perhaps isn’t seeing the level of clinical benefit that they or the patient were hoping for. Then they get referred to us.”

Neurological referrals are common as well. “We also see people who are very severe, very refractory, who are typically referred by a neurologist,” Dr. Donnelly said. “At this point, they’ve probably tried 10 to 15 different medications and are not reaching the benefit they need.”

The team follows clinical and standard diagnostic approaches.

Dr. Donnelly: “The diagnosis of migraine is a purely clinical diagnosis per a position statement by the American Headache Society, the American Academy of Neurology and the American Board of Internal Medicine: If the patient’s history is consistent with migraine and there is no red flag on history, we do not image. But if there is concern about secondary headaches with an ominous cause like tumor or aneurysm, we use standard diagnostic modalities like an MRI or a neuro-ophthalmologic exam, or an EEG if there’s concern about seizures.”

The team routinely provides consultations for patients who are pregnant and have neurological conditions.

Dr. Donnelly: “I am often consulted to field questions about the safety of vaginal vs. C-section births, as well as the safety of spinal anesthesia. This may be for somebody who has an arteriovenous malformation, or AVM, in pregnancy, or known aneurysm in pregnancy. So I do risk stratification and discussion of current literature when it comes to helping the obstetricians and maternal-fetal medicine providers with their decision-making in birth plans.”

The team also provides consultations for patients with neurological conditions who are considering conception.

Dr. Donnelly: “I often see people before pregnancy to discuss concerns around conditions like Dandy-Walker malformation and AVM, and whether pregnancy is even recommended in terms of safety with certain neurological conditions.”

The Novant Health team emphasizes lifestyle and nutraceutical approaches to treatment in conjunction with medical treatment options, regardless of neurological condition.

Dr. Donnelly: “I talk about lifestyle or nutraceutical approaches with every single patient. With migraine, for example, I talk about the importance of sleep and hydration, of eating healthy foods. I share the potential list of food triggers with every single one of my initial patients. And I talk about various vitamins and supplements that have been studied and have clinical evidence for helping reduce the frequency of migraines. That’s a good foundation for everybody. In addition to that, I utilize the full spectrum of medications, novel therapies and devices that are FDA-approved and commercially available.”

With Novant Health, every patient receives individualized care and support.

Dr. Donnelly: “My goal is for each person to walk out of their visit feeling listened to and truly heard, and that they feel like they have a solid plan in place and the knowledge that if the plan doesn’t work right off the bat, they have someone they can turn to for backup and change of plan.”